烟雾病血管病患者血运重建手术对与脑血管反应性相关头痛的影响

The Impact of Revascularization Surgery on Headaches in Association with Cerebrovascular Reactivity in Patients with Moyamoya Angiopathy.

作者信息

Gallego Moyano Francy D, Janssen Helena C, Venkatraghavan Lashmi, Mikulis David J, Andrade Barazarte Hugo, Radovanovic Ivan, Hendriks Eef J, Schaafsma Joanna D

机构信息

Department of Medicine, Division of Neurology, University Health Network (UHN), 399 Bathurst St., Toronto, ON M5T 2S8, Canada.

Department of Anesthesiology, University Health Network (UHN), Toronto, ON M5T 2S8, Canada.

出版信息

Brain Sci. 2024 Sep 26;14(10):967. doi: 10.3390/brainsci14100967.

DOI:10.3390/brainsci14100967

PMID:39451981

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11506590/

Abstract

BACKGROUND/OBJECTIVES: Headaches in Moyamoya angiopathy are common but poorly understood. We aimed to investigate if headaches in Moyamoya angiopathy improve after revascularization surgery and whether this is associated with improvement in cerebrovascular reactivity on MRI (CVR-MRI).

METHODS

We included consecutive adult patients with Moyamoya angiopathy who had chart data on headaches, CVR-MRI, and underwent extracranial-intracranial bypass surgery between January 2010 and September 2022 at a tertiary neurovascular referral center. Clinical and CVR-MR imaging data of all patients were collected through systematic chart review, complemented by standard-of-care headache questionnaires from patients who were operated between 2018 and 2022. We evaluated headache features and explored the association between headaches and CVR before and after revascularization surgery.

RESULTS

Fifty-nine patients were included (mean age 47 ± 14 years, 43 females (73%)); among them, 41/59 (69%) reported headaches pre-surgery. Headache improved in 28/41 (68%) patients after revascularization surgery with a reduction in pain severity (median VAS-score from 5/10 to 2.5/10; = 0.002), analgesic use (from 84% to 40%; = 0.007), and sick leave (from 60% to 16%; < 0.001). Improvement in headaches was associated with improvement in CVR (OR 5.3; 95% CI: 1.2-23.5) and sick leave reduction (OR 1.4; 95% CI: 1.6-121.4).

CONCLUSIONS

Headaches in Moyamoya angiopathy are common and disabling. They may improve in most patients after revascularization surgery and seem to be associated with improvement in CVR, supporting the hypothesis of a potential vascular origin of the headaches.

摘要

背景/目的：烟雾病性头痛很常见，但人们对此了解甚少。我们旨在研究烟雾病性头痛在血运重建手术后是否会改善，以及这是否与MRI上脑血管反应性（CVR-MRI）的改善有关。

方法

我们纳入了2010年1月至2022年9月期间在一家三级神经血管转诊中心连续就诊的成年烟雾病患者，这些患者有关于头痛、CVR-MRI的图表数据，并接受了颅外-颅内搭桥手术。通过系统的图表审查收集所有患者的临床和CVR-MR成像数据，并辅以2018年至2022年期间接受手术患者的标准护理头痛问卷。我们评估了头痛特征，并探讨了血运重建手术前后头痛与CVR之间的关联。

结果

纳入59例患者（平均年龄47±14岁，43例女性（73%））；其中，41/59（69%）在手术前报告有头痛。28/41（68%）的患者在血运重建手术后头痛得到改善，疼痛严重程度降低（VAS评分中位数从5/10降至2.5/10；P = 0.002），镇痛药使用减少（从84%降至40%；P = 0.007），病假减少（从60%降至16%；P < 0.001）。头痛的改善与CVR的改善（OR 5.3；95%CI：1.2 - 23.5）和病假减少（OR 1.4；95%CI：1.6 - 121.4）相关。